At the time of the revision of a failing femoral prosthesis, a triple initiative is imperative regardless of the implant that is used:
• Choose a concept perfectly defined with objectives easy to achieve on the surgical plan
• Prepare the intervention in a rigorous and logical way (preoperative planning)
• Establish a coherent surgical technique, i.e. in accordance with the chosen concept, to reach the objectives defined during the preparatory phase of the intervention.
LBA education gives surgeons a set of applications constituing a teaching aid and an assistance before and during the revision of a loosened femoral prosthesis with a modular uncemented straight stem of press-fit concept (Revitan ® straight)
• A coud understanding of the concept chosen to prepare the intervention properly. An operator will always have difficulties in realizing a surgical gesture if he did not understand its interest. ; on the other hand, if he has a clear perception of the objectives to achieve, he will easily make a surgical gesture which, in first analysis, can seem to him not very obvious or excessive. Every concept has its imperatives (for the press-fit concept it is, above all, to insure a bone-implant contact in the form of a surface) and if the operator has no precise idea of the goals to achieve, a surgical operation will always be risky .
• Choose a strategy in compliance with the concept of the adopted implant. The preoperative planning takes place in 3 stages:
- Radiological analysis of the femur which should not be limited to an assessment of bone defects and the presence of difficulties for cement extraction. The femur should be evaluated on the whole with, in particular, an evaluation of the morphotype: a curvature, even little accentuated, can prevent a bone-implant contact in the form of a surface. It is the same for the osteoporosis which presence can compromise a result in the medium or long term when the choice of an uncemented stem has been made.
- Choose a surgical strategy… This means first of all choosing a femoral approach (endo or transfemoral) knowing that with a press-fit concept stem, it is always advisable to be near the zone of anchoring and to work on a rectilinear femoral segment. The zone of femur where primary stability can be achieved depends on this choice. It is also at this point that it becomes obvious whether the press-fit concept is not recommended or cannot be applied.
- Make a preoperative template to visualize possible obstacles that could prevent a rigorous application of the press-fit concept and to determine the reference measures that can be used during surgery.
• Establish a coherent surgical technique i.e. strictly in compliance with the chosen concept and the strategy defined by the operator during the phase of planning. Every surgical gesture has a precise objective and the implantation of a prosthesis must be never considered as a succession of "recipes" or " tips and tricks " which, put end to end, will lead to success of a surgical operation. This way of reasoning or more exactly of "not reasoning" entails, certainly, a long period of learning or even a chronic incapacity to perform a precise and adapted surgical act.
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